Necrólise epidérmica tóxica/síndrome de Stevens Johnson: emergência em dermatologia pediátrica

Contexto: É descrito caso clínico de farmacodermia grave e de alta letalidade, cujo reconhecimento imediato é fundamental. Relato decaso: Paciente do sexo masculino de três anos de idade, cuja mãe refere histórico de crises convulsivas, consultou-se com neurologistaparticular, que prescreveu ácido valproico. Uma semana depois, voltou a ter crise convulsiva, sendo então introduzida lamotrigina.Poucos dias depois, a criança começou apresentar tosse e coriza hialina. Procurou pronto-socorro de sua cidade e foi orientada a usarfluimucil. Iniciou, então, febre e exantema máculo-papular inicialmente na face, que depois se generalizou. Foi levantada a hipótesediagnóstica de farmacodermia secundária à associação de anticonvulsivante. Discussão: Síndrome de Stevens-Johnson e necróliseepidérmica tóxica são variantes do mesmo processo mucocutâneo agudo, raro e grave, causado principalmente por reação adversaa fármacos e caracterizado por erupção cutânea macular de padrão eritematoso, formação de bolhas de conteúdo sero-hemático edestacamento epidérmico. As afecções são diferenciadas pela porcentagem de superfície corpórea acometida, sendo menor que10% na síndrome de Stevens-Johnson, e maior que 30% na necrólise epidérmica tóxica. O prognóstico pode ser estimado através doescore Severity Illness Score for Toxic Epidermal Necrolysis (SCORTEN), que prevê mortalidade de até 90% para os casos mais graves.O tratamento consiste na interrupção imediata da droga, transferência do paciente para unidade de queimados ou unidade de terapiaintensiva, e medidas de suporte. Terapias adjuvantes, como imunoglobulinas intravenosas e corticosteroides, ainda não têm papelconsolidado na literatura. Conclusões: Relata-se afecção rara e extremamente grave cuja suspeição clínica é importante na conduçãodo tratamento.

David Bancroft Johnson Travel Journals - Accession 32 - M9 (32)

The David Bancroft Johnson Travel Journals Collection consists of a diary of a trip taken by David Bancroft Johnson, Founder and First President of Winthrop, to Belgium, Holland, Germany, Switzerland, France, England, and Scotland during October- December 1908. The journals contains descriptions of areas visited, social life and customs. Also included is a description of his trip to Denver, Colorado in July 1909 in which he describes the area and its people.

Omtvedt Innovation Awards Presented to Chris Calkins, Steven Jones, Rodger Johnson, and Sheila Scheideler

It's a great pleasure to welcome you to this very first recognition ceremony for the Omtvedt Innovation Awards. We are present here to honor innovation strengths of the Institute of Agriculture and Natural Resources, and certainly the four faculty members receiving today's awards are greatly deserving of this recognition. Just hearing about their work is gratifying!

NUTRITIONAL BALANCE, ESSENTIAL OIL AND WOOD PRODUCTION FROM Corymbia citriodora Hill & Johnson WITH SEWAGE SLUDGE AND MINERAL FERTILIZER APPLICATIONS

The Corymbia citriodora is one of the most important forest species in Brazil and the reason is the diversity of its use, because it produces good quality wood and the leaves may be used for essential oil production. Although, there are not many studies about species and the handling effect in the nutritional balance. This study aimed to evaluate the biomass production and nutrient balance in the conventional production of essential oil and wood of Corymbia citriodora with sewage sludge application. The experiment design established was the randomized blocks, with four replicates and two treatments: 1 - fertilization with 10 tons ha(-1) (dry mass) of sewage sludge, supplemented with K and B, and 2 - mineral fertilization. It was evaluated the aerial biomass production, the nutrient export of the leaves, the essential oil and wood production at four years old. The trees that received application of sewage sludge produced 20 % more leaves biomass than the trees with mineral fertilization, resulting in larger oil production. Besides, the trees with sewage sludge application produced 14.2 tons ha(-1) yr(-1) of woody biomass that was 27 % higher than the treatment with mineral fertilization. For both treatments the N balance was negative, but treatment with sewage sludge application (-45 kg ha(-1)) was four times lower than the observed on mineral fertilization treatment (-185 kg ha(-1)). It may be concluded in this paper that the application of sewage sludge benefits the production of leaves biomass, essential oil and wood, besides result better nutritional balance of the Corymbia citriodora production system.

1963-1968. Dall'avvento dell'amministrazione di Lyndon B. Johnson al Trattato di Non-Proliferazione. gli Stati Uniti, la Francia, la NATO e l'Europa agli esordi della distensione. Storia di una "non-crisi" transatlantica e della riorganizzazione dell'Alleanza.

The aim of this proposal is to explain the paradigm of the American foreign policy during the Johnson Administration, especially toward Europe, within the NATO framework, and toward URSS, in the context of the détente, just emerged during the decade of the sixties. During that period, after the passing of the J. F. Kennedy, President L. B. Johnson inherited a complex and very high-powered world politics, which wanted to get a new phase off the ground in the transatlantic relations and share the burden of the Cold war with a refractory Europe. Known as the grand design, it was a policy that needed the support of the allies and a clear purpose which appealed to the Europeans. At first, President Johnson detected in the problem of the nuclear sharing the good deal to make with the NATO allies. At the same time, he understood that the United States needed to reassert their leadeship within the new stage of relations with the Soviet Union. Soon, the “transatlantic bargain” became something not so easy to dealt with. The Federal Germany wanted to say a word in the nuclear affairs and, why not, put the finger on the trigger of the atlantic nuclear weapons. URSS, on the other hand, wanted to keep Germany down. The other allies did not want to share the onus of the defense of Europe, at most the responsability for the use of the weapons and, at least, to participate in the decision-making process. France, which wanted to detach herself from the policy of the United States and regained a world role, added difficulties to the manage of this course of action. Through the years of the Johnson’s office, the divergences of the policies placed by his advisers to gain the goal put the American foreign policy in deep water. The withdrawal of France from the organization but not from the Alliance, give Washington a chance to carry out his goal. The development of a clear-cut disarm policy leaded the Johnson’s administration to the core of the matter. The Non-proliferation Treaty signed in 1968, solved in a business-like fashion the problem with the allies. The question of nuclear sharing faded away with the acceptance of more deep consultative role in the nuclear affairs by the allies, the burden for the defense of Europe became more bearable through the offset agreement with the FRG and a new doctrine, the flexible response, put an end, at least formally, to the taboo of the nuclear age. The Johnson’s grand design proved to be different from the Kennedy’s one, but all things considered, it was more workable. The unpredictable result was a real détente with the Soviet Union, which, we can say, was a merit of President Johnson.

L'amministrazione Johnson e le origini della distensione. 1964-1968

La tesi analizza una parte della politica estera dell’amministrazione Johnson, e più specificamente l’avvio del dialogo con l’Urss in materia di non proliferazione e controllo degli armamenti e la revisione della China policy, inquadrando entrambe nell’adattamento della cold war strategy all’evoluzione sistema internazionale, argomentando che la distensione intesa come rilassamento delle tensioni e ricerca di terreno comune per il dialogo, fosse perlomeno uno degli strumenti politici che l’amministrazione scelse di usare. Il primo capitolo analizza i cambiamenti che interessarono il Blocco sovietico e il movimento comunista internazionale tra la fine degli anni Cinquanta e l’inizio degli anni Sessanta, soprattutto la rottura dell’alleanza sino-sovietica, e l’impatto che essi ebbero sul sistema bipolare su cui si basava la Guerra Fredda. Il capitolo secondo affronta più specificamente l’evoluzione delle relazioni tra Stati Uniti e Unione Sovietica, il perseguimento di una politica di distensione, dopo la crisi dei missili cubani, e in che relazione si trovasse ciò con lo status della leadership sovietica a seguito dei cambiamenti che avevano avuto luogo. Soffermandosi sulla questione del controllo degli armamenti e sul percorso che portò alla firma del Trattato di Non-proliferazione, si analizza come la nuova rotta intrapresa col dialogo sulle questioni strategiche sia stato anche un cambiamento di rotta in generale nella concezione della Guerra Fredda e l’introduzione della distensione come strumento politico. Il terzo capitolo affronta la questione della modifica della politica verso Pechino e il processo tortuoso e contorto attraverso cui l’amministrazione Johnson giunse a distaccarsi dalla China policy seguita sino ad allora.

Toxic epidermal necrolysis and Stevens-Johnson syndrome: a review

The aims of this review are to summarize the definitions, causes, and clinical course as well as the current understanding of the genetic background, mechanism of disease, and therapy of toxic epidermal necrolysis and Stevens-Johnson syndrome.

Montana In the 1970’s: Seen Through a Reporter’s Eyes -- Chuck Johnson “In the Crucible of Change”

It has been said that “journalism is the first rough draft of history.” If that be the case, much of Montana’s history since 1970 was first written by Chuck Johnson. He has covered the activities of 20 regular sessions of the Legislature plus an untold number of Special Sessions, the Constitutional Convention, nine Governors, eight US Senators and seven US Congressmen. Primary elections, general elections, state and national Party Conventions have been seen by Montanans through Johnson’s prism. Big and little news about policy, insights about politics, and a sense of the people behind the news (and history) has flowed from Chuck Johnson’s pen. Johnson’s first decade as a journalist coincides substantially with the period of “In the Crucible of Change.” Having been one of those who wrote the first draft of much of the history in the series “In the Crucible of Change,” and as “Dean of Montana’s Capitol Reporters,” Chuck’s reflections and insights about the period are conveyed in this film with a maturity and understanding that can only come from one who has spent decades honing is craft to perfection. Chuck Johnson is a journalist who has covered Montana state government and politics since 1970. Since 1992, he has been bureau chief of the Lee Newspapers State Bureau in Helena, writing for the Lee daily newspapers: the Billings Gazette, The Montana Standard (Butte), Helena Independent Record, The Missoulian, and the Ravalli Republic (Hamilton). Johnson, a Great Falls native raised in Helena, was exposed to politics early on when he was taken up to the Legislature one night to watch the debate on the raging issue of the day--whether stores should be allowed to give trading stamps to customers. He received a B.A. in journalism and an M.A. history from the University of Montana. Johnson spent a year studying politics and economics at Oxford University in England on a Rotary Foundation scholarship. He previously was chief of the Great Falls Tribune Capitol Bureau and worked for the Associated Press, Missoulian and Helena Independent Record. Chuck and his wife Pat reside in Helena.

In vitro drug causality assessment in Stevens-Johnson syndrome - alternatives for lymphocyte transformation test

BACKGROUND Patients with Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) are often exposed simultaneously to a few potentially culprit drugs. However, both the standard lymphocyte transformation tests (LTT) with proliferation as the assay end-point as well as skin tests, if done, are often negative. OBJECTIVE As provocation tests are considered too dangerous, there is an urgent need to identify the relevant drug in SJS/TEN and to improve sensitivity of tests able to identify the causative drug. METHODS Fifteen patients with SJS/TEN with the ALDEN score ≥ 6 and 18 drug-exposed controls were included. Peripheral blood mononuclear cells (PBMC) were isolated and cultured under defined conditions with drugs. LTT was compared to the following end-points: cytokine levels in cell culture supernatant, number of granzyme B secreting cells by ELISpot and intracellular staining for granulysin and IFNγ in CD3(+) CD4(+), CD3(+) CD8(+) and NKp46(+) cells. To further enhance sensitivity, the effect of IL-7/IL-15 pre-incubation of PBMC was evaluated. RESULTS Lymphocyte transformation tests was positive in only 4/15 patients (sensitivity 27%, CI: 8-55%). Similarly, with granzyme B-ELISpot culprit drugs were positive in 5/15 patients (sensitivity 33%, CI: 12-62%). The expression of granulysin was significantly induced in NKp46(+) and CD3(+) CD4(+) cells (sensitivity 40%, CI: 16-68% and 53%, CI: 27-79% respectively). Cytokine production could be demonstrated in 38%, CI: 14-68% and 43%, CI: 18-71% of patients for IL-2 and IL-5, respectively, and in 55%, CI: 23-83% for IFNγ. Pre-incubation with IL-7/IL-15 enhanced drug-specific response only in a few patients. Specificities of tested assays were in the range of 95 (CI: 80-99%)-100% (CI: 90-100%). CONCLUSIONS AND CLINICAL RELEVANCE Granulysin expression in CD3(+) CD4(+) , Granzyme B-ELISpot and IFNγ production considered together provided a sensitivity of 80% (CI: 52-96%) and specificity of 95% (80-99%). Thus, this study demonstrated that combining different assays may be a feasible approach to identify the causative drug of SJS/TEN reactions; however, confirmation on another group of patients is necessary.

[Drug-induced Stevens-Johnson syndrome in a patient with AIDS]

The Stevens-Johnson syndrome is a severe potentially life-threatening form of the erythema multiforme, affecting both skin and mucous membranes. We present a case of a 49-year-old male patient with AIDS who developed a Stevens-Johnson syndrome while being treated with pyrimethamine, sulfadiazine and phenytoin for cerebral toxoplasmosis. Further diagnostic evaluation of this dangerous cutaneous affection may prove difficult for several reasons. In particular, in patients with AIDS who are more susceptible for adverse drug reactions and who are simultaneously receiving a variety of drugs with a considerable potential of cutaneous side effects, therapy cannot be withhold for lack of therapeutic alternatives. Moreover, the low lymphocyte count in this case may have made reliable testing with lymphocyte transformation studies impossible. The evaluation and the differential diagnosis of the drug-induced Stevens-Johnson syndrome are discussed. Especially long- and moderately long-acting sulfonamides belong to the most important agents that can cause a drug-induced Stevens-Johnson syndrome. The pathogenesis and the risk factors for cutaneous hypersensitivity reactions in HIV-infected patients are only poorly understood. These kind of reactions, however, seem to occur more often in patients with a more advanced immunodeficiency.

"An attentive Ear, a watchful Eye, and a Calm judicious Pen": William Samuel Johnson, the Colonial Agents, and the Transformation of the British Atlantic World

By looking at Great Britain and the American colonies in conjunction with the larger British Atlantic Empire, historians can better understand the political, social, and cultural transformations that occurred when transatlantic actors met. William Samuel Johnson is an example of an "ordinary" agent who nonetheless had extensive contacts with numerous British and American thinkers. While acting on Connecticut's behalf in London between 1767 and 1771, he sent reports back to Connecticut governors Jonathan Trumbull and William Pitkin on parliamentary proceedings while corresponding with the people who traveled around the Atlantic world during this critical period-merchants, seafarers, emigrants, soldiers, missionaries, radicals and conservatives, reformers, and politicians. He is also representative of the late eighteenth-century empire writ large. Agents, who had once been a source of stability in the far-flung colonies, became a destabilizing force as confusion and conflict grew over conceptual ideas of what constituted "the empire" and who was included in it. Johnson was a sane observer in the midst of the ideological and administrative upheaval of the 1760's and 1770's. His subsequent loyalism and political obscurity during the war years was in many ways a result of his attempts to reconcile various factional interests during his tenure as an agent. Although he did his best to resolve these divisions and provide an accurate account of the powerful nationalistic forces gathering on both sides of the Atlantic on the eve of the American Revolution, the agents' collective failures as transatlantic mediators helped bring about the collapse of an imperial community. This disintegration had dramatic effects on the whole of the Atlantic world.

Martin Johnson: Simba, Filmabenteuer ... [Rezension]

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Martin Johnson: Das Löwenbuch [Rezension]

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